A note from the Chair: Dear colleagues,
Welcome to the 9th
IPAC bulle�n
– the first for 2017. I was very
pleased to present the work of
IPAC at the SAGE mee�ng in
WHO headquarters at the end of
April. I men�oned the variety of
work we did in virtual mode via
TechNet21, email and teleconfer-
ence in 2016, and highlights from
our February mee�ng, which is
also summarised elsewhere in
this bulle�n. You can find my
presenta�on at the SAGE
mee�ng page at: h4p://
www.who.int/immuniza�on/
sage/mee�ngs/2017/april/en/
This link also hosts a web-
summary of SAGE proceedings,
focused on vaccine specific top-
ics, with several conclusions high-
ly relevant to immuniza�on prac-
�ce. On polio eradica�on, this
summary outlines the con�nuing
need in the short-term for Inac�-
vated Polio Vaccine (IPV) to be
given as frac�onal dosing, where
this is prac�cal, to ameliorate
vaccine supply shortages. The
summary also notes the need to
priori�se IPV use in rou�ne im-
muniza�on especially in Tier 1
and 2 countries, and recommen-
da�ons for the future incorpora-
�on of IPV into rou�ne schedules
a:er global OPV withdrawal. Re-
garding cholera vaccine, mass
vaccina�on campaigns were dis-
cussed as likely to be the most
prac�cal op�on for service deliv-
ery, in addi�on to the synergies
between vaccina�on and water,
sanita�on and hygiene interven-
�ons. Service delivery op�ons for
ebola vaccines, in this period
when no vaccine is yet licensed,
and diphtheria were also dis-
cussed along with other pro-
gramma�c implica�ons such as
enhanced surveillance.
Cross-cu<ng programma�c top-
ics were also discussed at SAGE,
including new evidence on the
role of the private sector in im-
muniza�on, strengthening na-
�onal immuniza�on advisory
groups, and a session on na�onal
immuniza�on programme man-
agers. This session included
country case studies from Paki-
stan and Armenia and the work
of USA CDC and partners in ap-
plying a competency framework
to mapping and defining the
func�ons needed at the na�onal
level. IPAC members will recall
discussing this topic in February,
with several members offering
inputs. Proposed global guidance
to strengthen immuniza�on pro-
gramme management is under
development, including a guid-
ance document on key func�ons
and competencies, and tools for
workforce mapping.
Lastly, I’m pleased to see IPAC’s
new Terms of Reference that re-
aligns us with other advisory
commi4ee processes, commits to
annual IPAC mee�ngs, and bal-
ances two aspects of our man-
date: applying a programma�c
lens to innova�ons, and the need
to strengthen exis�ng systems.
This also updates IPAC’s forward
agenda, of which more in future
bulle�ns. This bulle�n is reaching
you a week or so late, my apolo-
gies, due to my rapid transit from
SAGE to evalua�on work in Lha-
sa, from where I send you my
gree�ngs,
Chris MorganChris MorganChris MorganChris Morgan
April 2017
WORLD HEALTH ORGANIZATION Volume 3, Issue 1
IPAC BULLETIN QUARTERLY UPDATE OF THE IMMUNIZATION PRACTICES ADVISORY COMMITEE
Inside this issue: From the Working Group frontlines 2
IPAC Meeting and TOR updates 3
CCEOP Workshop: Example of Burkina Faso 4-5
Upcoming meetings and events 6
A final word from the IPAC Secretariat 6
Home-based record revitalization workshop 5
Special Issue of Vaccine on Supply Chains 6
Page 2 IPAC BULLETIN
From the Working Group frontlines
CTC Working Group update
by Anna-Lea Kahn (CTC fo-
cal point at WHO and part
of the CTC-WG Secretariat)
The IPAC Working Group on the
Controlled Temperature Chain
(CTC-WG) met in person in Gene-
va on 13 February 2017, in order
to make important headway on
the cri�cal task of defining a clear
and precise strategic direc�on for
the CTC agenda. Central to this
task was the stock-taking exercise
of examining progress to date
and understanding where the
main barriers lie to capitalizing on
the thermostability of vaccines.
Having a full day, face-to-face
mee�ng of experts and stake-
holders on this subject, in con-
trast to the usual 90 minute tele-
conferences that are scheduled
every two months, allowed for a
more thorough discussion during
which the concepts and reason-
ing underpinning the CTC ap-
proach to vaccine delivery could
be further considered and the
varied perspec�ves and insights
on priori�es with respect to the
program of work in support of
CTC were shared. This valuable
mee�ng concluded with consen-
sus on a forward path for the CTC
work-stream, including the selec-
�on of four vaccines which
should benefit from focused
a4en�on and support in order to
ensure the appropriate momen-
tum both in upstream efforts to
bolster supply of CTC-compa�ble
vaccines and downstream, coun-
try-level efforts to facilitate up-
take, measure benefits, and
boost demand for such vaccines.
As detailed in the mee�ng report
that is available on request from
the CTC-WG Secretariat, the four
vaccines iden�fied as priority for
the CTC program consist of 1)
Human papillomavirus vaccine
(HPV), (2) Oral Cholera Vaccine
(OCV), (3) Tetanus Toxoid (TT)-
containing vaccine, and (4) Hepa-
��s B birth dose vaccine.
As this is a newly established
working group, mee�ng in person
also provided an opportunity for
members to be introduced to one
another and develop a more co-
hesive dynamic herea:er. Having
a full day to interact offered the
group a unique opportunity to
exchange views and achieve a
shared vision for CTC, which was
indeed among the principal ob-
jec�ves of the mee�ng, as de-
tailed in the December issue of
the IPAC Quarterly Bulle�n. The
mee�ng outcomes were present-
ed to IPAC for informa�on and
approval during its 14-16 Febru-
ary mee�ng, leading to confirma-
�on of the proposed priori�es
and interest in the detailed
roadmap under development for
each of the four priority vaccines.
The la4er document was the
main subject of discussion of the
WG’s teleconference in late April
and an ini�al dra: is expected to
be completed by the end of June
2017, with an aim of seeking fur-
ther approval from IPAC shortly
therea:er.
It should be noted that carrying
out the proposed ac�vi�es under
the CTC work plan will be con�n-
gent on the WHO-PATH imple-
menta�on partnership securing
required funding. At present,
funding limita�ons are responsi-
ble for some disrup�on in WHO’s
ability to fully implement the CTC
program, as well as provide ade-
quate human resource capacity
to this area of work. A direct con-
sequence has been the inability
to further renew the consul�ng
contract of Dörte Pe�t who had
been ac�vely involved in imple-
men�ng Meningi�s A vaccina�on
through CTCs, as well as assis�ng
with the facilita�on of this work-
ing group. The CTC-WG Secretari-
at would like to take this oppor-
tunity to thank Dörte for her var-
ied and invaluable support to CTC
over the past two and a half years
and we wish her much success in
her future projects. In the inter-
im, Carmen Au from WHO has
joined the working group’s secre-
tariat, she will help ensure its
con�nued smooth running.
The next teleconference of the
CTC-WG is scheduled for
Wednesday, June 28th at 3pm
CET. Anyone interested is wel-
come to join these calls. Please
contact Carmen Au
([email protected]) for further details.
WHO/EPI— transporting vaccines
outside the cold chain
Page 3 VOLUME 3, ISSUE 1
As highlighted by IPAC Chair, Chris
Morgan, during his opening note
of the December issue of this Bul-
le�n, the Commi4ee’s Secretariat
sought the assistance of an exter-
nal consultant (former IVB staff
member, Dr Carsten Mantel) to
examine and revise the Com-
mi4ee’s terms of reference (TORs)
so as to ensure the Commi4ee is
suppor�ng WHO as effec�vely as
possible in its work to strengthen
and improve the delivery of im-
muniza�on programmes, as per
the goals of the Global Vaccine
Ac�on Plan (GVAP). The TOR revi-
sion exercise was conducted
through a consulta�on process
that allowed for input from a
broad range of stakeholders, in-
cluding most importantly, senior
technical staff within the Immun-
iza�on, Vaccines and Biologicals
(IVB) department at WHO. Among
the objec�ves was also the align-
ment of IPAC’s mandate and oper-
a�ons with those of the other ad-
visory commi4ees serving IVB in
parallel- notably, the Immuniza-
�on and Vaccines related Imple-
menta�on Research Advisory
Commi'ee (IVIR-AC) and the Prod-
uct Development for Vaccines Ad-
visory Commi'ee (PDVAC). Some
of the governance prac�ces of
IPAC were modified to echo those
applied to the Strategic Advisory
Group of Experts on Immuniza�on
(SAGE), and other WHO Com-
mi4ees.
A:er further feedback provided
by IPAC during its February 2017
mee�ng and several rounds of
revision following input from the
IVB leadership, the latest internal-
ly approved version of the IPAC
TORs were shared with the SAGE
in advance of its 25-27 April 2017
mee�ng, appearing in the back-
ground literature- or “yellow
book”- provided to SAGE and
mee�ng par�cipants. SAGE mem-
bers have been offered the oppor-
tunity to comment on the new
TORs prior to their finaliza�on by
the end of May 2017.
Among the important changes
featured in the new IPAC TORs are
annual mee�ngs during the first
quarter of each year, a reduc�on
in Commi4ee members from 15 to
11, and the complete removal of
dedicated observer seats on the
Commi4ee. While IPAC’s general
mandate remains unchanged, the
new core technical areas bene-
fi�ng its focus are now defined as:
• Innova�ons for equitable im-
muniza�on coverage
• Immuniza�on Service Delivery
and Programme Management.
The mee�ng report emerging
from IPAC's mee�ng in Geneva
from 14-16 February 2017 is now
available online on the website
for the WHO Department for Im-
muniza�on, Vaccines, and Biolog-
icals (IVB) at the following link:
h'p://www.who.int/immuniza�on/
programmes_systems/
policies_strategies/ipac/en/
It provides a summary of each of
the six sessions held during the
first two days of the mee�ng,
which focused on key technical
issues the IVB Department is cur-
rently dealing with. These ses-
sions consisted of:
I. Immuniza�on supply chain
and logis�cs
II. Global supply, shortages and
implementa�on solu�ons
III. Immuniza�on in the second
year of life
IV. Controlled temperature chain
working group – update
V. Delivery Technology working
group – update
VI. Immuniza�on advisory com-
mi4ees – updates
The third day of the mee�ng was
dedicated to internal opera�ons
and governance issues, including
discussion of the new Terms of
Reference under development for
the Commi4ee .
IPAC provided advice on: (1)
WHO’s Data Reference Manual
and guidance to address the in-
creasing demands on data and
monitoring imposed by more
complex programmes. (2) WHO’s
opera�onal guidance on vaccina-
�on in the Second Year of Life. (3)
The Controlled Temperature
Chain (CTC) roadmap for the next
wave of vaccines to priori�ze for
on-label single excursions beyond
the cold chain. (4) The Delivery
Technology working group map-
ping of innova�ons in vaccine
delivery and product presenta-
�on; including the final target
product profile for measles and
rubella containing micro-array
patches.
IPAC 14-16 February 2017 Meeting: a brief summary
IPAC Terms of Reference: update on the ongoing revisions
WHO / Grevendonk, J.
Page 4 VOLUME 3, ISSUE 1
The Cold Chain Equipment Op�-
miza�on PlaPorm (CCEOP) is a
salutary ini�a�ve of GAVI Alliance
that supports eligible countries to
strengthen their supply chains by
acquiring new, high-quality, high-
performance refrigera�on equip-
ment that meets standards. The
support from the CCEOP requires
the submission of a robust pro-
posal, including several mandato-
ry documents.
Many countries in the region
were facing some challenges to
prepare for the required docu-
ments to support their proposals.
Par�cularly, Burkina Faso is in a
cri�cal situa�on as its 2012 Effec-
�ve Vaccine Management (EVM)
will exceed the five years limit for
EVM assessment a:er June 2017.
As part of the subsequent EVM
assessment, the country will be
required to update its inventory
of cold chain equipment. Taking
into account the cri�cal situa�on
of the cold chain and the urgent
need to replace non-func�onal
and obsolete equipment, Burkina
Faso requested technical assis-
tance of the GAVI Alliance part-
ners through AFRO/IST-WA and
UNICEF/WCARO.
In response to the request from
the Ministry of Health Burkina, a
workshop was organized to sup-
port country readiness to GAVI
CCEOP. In order to maximize the
opportunity of technical support
being mobilized, the workshop
was further extended to four oth-
er countries that face similar
challenges, including Benin, Cen-
tral African Republic (CAR), Cote
d’Ivoire and Senegal.
The mission consisted of a three
to five day country workshop to
support Burkina Faso, following a
week of inter-country workshop
for the four other countries.
A. Country workshop to support
Burkina Faso:
Specific support provided to
Burkina Faso includes the review
of the following mandatory docu-
ments:
• Cold chain equipment invento-
ry data cleaning;
• Cold chain equipment invento-
ry report review;
• Cold chain essen�al es�ma�on
methods and scenarios;
• Cold chain rehabilita�on and
expansion plan;
• Na�onal Health strategic docu-
ments (plan, service delivery
mapping, etc.).
The result of the workshop
strengthened the capacity of the
new logis�cs team. An update
was provided on tools for moni-
toring vaccine stock availability
and u�liza�on in the na�onal
immuniza�on programme.
B. Inter-country workshop to
support other countries:
For the CCEOP proposal, the par-
�cipa�ng countries demonstrat-
ed different stages of readiness.
With the excep�on of CAR, all
countries recently updated their
cold chain equipment inventory.
Data cleaning and valida�on, as
well as dra:ing reports were all
necessary to complete for all
countries. During the workshop,
the countries were facilitated
through the finaliza�on of man-
datory documents:
• Development of facility seg-
menta�on and ra�onal for cold
chain equipment selec�on;
• Development of 5-year cold
chain equipment deployment
plan to cover two phases (i)
ini�al phase of urgent needs (ii)
extended phase for replace-
ment and expansion needs;
• Review of the maintenance
plan for cold chain equipment
and ensure that its funding is
adequately covered by govern-
ment funding or a development
partner;
• Ensure that the CCEOP country
joint-investment is taken into
account and, if necessary,
check consistency with the Gavi
Health System Strengthening
funding;
• Check consistency in the vari-
ous documents to be sub-
mi4ed.
Further, alignment on the CCEOP
applica�on guideline and form
UNICEF/ Ganivet, S.
UNICEF/ Ganivet, S.
CCEOP Country Support : example of Burkina Faso by Souleymane Kone
Page 5 VOLUME 3, ISSUE 1
was the next focus:
• Review Gavi CCEOP applica�on
guidelines;
• Familiarize and answer key
ques�ons on the CCEOP applica-
�on form;
• Check narra�ve and coherence
of the EPI logis�cs support ac�v-
i�es planned.
A:er the workshop, countries are
required to finalize their pro-
posals with all mandatory docu-
ments and make necessary en-
dorsement before submi<ng to
Gavi Secretariat for further WHO
pre-review. For the May round of
WHO pre-review, the deadline for
submission is 3rd May 2017. Coun-
tries will have another opportuni-
ty to submit their final proposal in
September 2017.
In the December 2016 (Volume 2,
Issue 4) issue of the IPAC Bulle�n,
the importance of well-designed,
durable and legibly completed
home-based records was
highlighted. During 21-24
February 2017, representa�ves
from Cameroon, Ethiopia, Liberia,
Nigeria, Rwanda and Uganda
gathered in Kampala, Uganda to
rethink and improve their
country’s current home-based
record design and func�onality as
well as the broader system that
supports the home-based record
to address issues such as stock-
outs described in this link h4ps://
goo.gl/aSqEF2
Par�cipants not only walked away
from the workshop with a
physical prototype of their
improved home-based records
(e.g., vaccina�on card, child
health book) but perhaps more
importantly an implementa�on
plan to move forward as well as a
convic�on that addressing the
needs of primary users ensures
that the home-based record is
valued by, and meaningful to, the
intended users.
Following a user-centered
approach, par�cipants of the
Africa workshop conducted pre-
workshop ac�vi�es that included
health facility visits to talk with
and observe caregivers and health
workers, as well as to collect
informa�on to map out how their
home-based records are
prepared, produced, distributed
and used. Par�cipants brought
this informa�on, which was
shared across country teams, as
input to the cross-country
workshop to help the teams think
beyond usual assump�ons and
ground their decisions on actual
observa�ons rather than
percep�on.
Par�cipants were also provided
with the ini�al framework of a
business case for investment in
home-based record systems, a
document which is available in
the following link: h4ps://goo.gl/
rP1mA7
We encourage readers to take a
quick read through the final
workshop report available
here : h4p://www.technet-
21.org/en/forums/discussions/
home-based-record-revitaliza�on-
workshop-in-africa-report-
summary on TechNet. Comments
are welcome.
Home-based record vaccination section
WHO / Digital Home-based record collection from Member States
CCEOP Country Support (Cont’d from page 4)
Home-based record revitalization workshop in Africa: Summary report - by David Brown
Page 6 VOLUME 3, ISSUE 1
Upcoming Meetings
& Events:
⇒ 05 May 2017 — Geneva, Switzerland:
WHO maternal influenza epidemiology
working group dissemination meeting
⇒ 22–31 May 2017 — Geneva, Switzerland:
Seventieth World Health Assembly
⇒ 29–31 May 2017 — Geneva, Switzerland:
SAGE WG on Typhoid Vaccines
⇒ 12-15 June 2017 — Geneva, Switzerland:
PCV Technical Expert Consultation and
SAGE WG on PCVs
⇒ 20–22 June 2017 — Geneva, Switzerland:
SAGE WG on Measles and Rubella
⇒ 26–29 June 2017 — Geneva, Switzerland:
15th Global Measles and Rubella
Laboratory Network (GMRLN) meeting
A final word from the IPAC Secretariat
Announcing a special
issue of Vaccine on
supply chains
A special issue on Immuniza�on Supply
Chains has just been released in Vaccine,
follow the link below!
Vaccine: Volume 35, Issue 17, Pages 2101
-2278 (19 April 2017): Building Next Gen-
era�on Immuniza�on Supply Chains
h4p://www.sciencedirect.com/science/
journal/0264410X/35/17
This Spring issue of the IPAC Bulle�n was prepared thanks to the skilled efforts of the latest
addi�on to the Supply, Technologies, and Financing (STF) team within the Expanded Pro-
gramme on Immuniza�on (EPI), Ms Carmen Au. Though Carmen has joined EPI as a consult-
ant to mainly assist the prepara�ons for the 2017 TechNet Conference taking place next Oc-
tober in Cascais, Portugal, she will also be offering support to the IPAC Secretariat. As you
will have noted from the CTC Working Group update, she has already been ac�ve with that
group too and so will probably con�nue to become a familiar name to you. Carmen has a
background in Biochemistry and has a proven track record as an excellent project manager.
The next main opportunity for discussion and dialogue for our Commi4ee will be during a
web-based teleconference we are hoping to schedule in early July. Members should stand by
for a doodle poll which will allow us to iden�fy the most appropriate �ming.
In the mean�me, IPAC members are invited to keep an eye on the IPAC online discussion
group for any addi�onal relevant announcements and discussions as a number of items are in
the pipeline for submission to IPAC in the coming months, such as the dra: CTC Priority Vac-
cine Roadmap.
The IPAC Secretariat Team